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Barriers in Neurogastroenterology and Motility Training Experience for Pediatric Gastroenterology Fellows

Graham, Kahleb*; Belkind-Gerson, Jaime; Darbari, Anil; Boyle, John T.*

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 806–810
doi: 10.1097/MPG.0000000000002282
Original Articles: Gastroenterology

Background: Neurogastroenterology and motility (NGM) disorders are common and have a high health care burden. Although pediatric gastroenterology fellows are expected to obtain comprehensive training in the diagnosis and management of NGM disorders, there is ongoing concern for unmet training needs and lack of exposure in treating patients who suffer from NGM problems.

Methods: We conducted a cross-section survey of trainees listed as pediatric gastroenterology fellows in North American training programs in 2018 via direct E-mail and the pediatric gastroenterology listserv. Eighty-one pediatric gastroenterology fellows responded to the anonymous survey.

Results: A total of 53.1% of the fellows reported interest in NGM; however, 75.1% of the fellows believed they had not been adequately trained in NGM during their fellowship. Eighty percent of fellows with 2 weeks or less of dedicated motility training reported that they received inadequate NGM training, compared to 46.2% fellows who received 1 or more months of dedicated motility training (P = 0.0148). The majority of fellows reported not being comfortable in performing gastrointestinal (GI) motility studies. The majority of fellows also reported not being comfortable in interpreting GI motility studies.

Conclusions: Although most pediatric gastroenterology fellows expressed interest in NGM, the lack of exposure and dedicated training in motility during fellowship were identified as barriers to pursuing motility-focused careers. Furthermore, most fellows reported limited comfort with performing and/or interpreting motility studies. Changes are needed to encourage fellows to develop their interest and expertise in NGM.

*Division of Pediatric Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, PA

Neurogastroenterology Program, Digestive Health Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO

Division of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC.

Address correspondence and reprint requests to Kahleb Graham, MD, Division of Pediatric Gastroenterology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (e-mail:

Received 15 August, 2018

Accepted 27 December, 2018

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,